October 14, 2009

This week was the European Association for the Study of Diabetes (EASD) meeting. This is the European equivalent of the ADA Scientific Session and in my experience it usually features some worthwhile research.

Of interest to many of my readers was yet another study proving the efficacy of the low carb diet. This one was done by Richard Feinman, PhD, from the Downstate Medical Center in Brooklyn, New York. His study found to the surprise of no one who owns and uses a blood sugar meter, that a low carb diet is much better than a high carb diet in controlling blood sugar. The diet used in this study was one that was 20% carbohydrate, which would be one of 100 grams for a 2000 calorie intake, just north of the boundary where most people start spilling ketones.

This diet did not produce weight loss--it was designed not to, but still achieved dramatic improvements in blood sugar, overturning the touching, if false, belief of most doctors and nutritionists that it is weight loss that lowers blood sugar, rather than the lowering of carbohydrate intake that occurs with calorie restricted weight loss diets.

My point in mentioning this is not that the research is all that significant. We've had lots of research over the years that demonstrated this same effect. What's interesting is that, surrounded by Europeans, rather than the Drug Company and Food Industry goons who dominate the American Diabetes Association, Dr. Feinman mentioned the elephant in the room.

Here's what he said, as reported by Diabetes in Control: "...the science is not controversial but policy regarding dietary control in diabetes is."

He then added,

"The recommendations are for relatively high carbohydrates. When you press the ADA [American Diabetes Association] for their recommendations, they say they do not have a specific diet, but in fact they recommend a high-carbohydrate [diet] and give grudging support to a restricted-carbohydrate diet."

"I'd really like to see an impartial panel of scientists that doesn't necessarily have any commitment to nutrition, [such as] physicists or meteorologists. The goal would be a clearer analysis of the facts, laying out the options, especially for people with diabetes. Let the patient and the physician make the decision.

Predictably, he was met with a hail of fact-free objection from nutritionists who responded much like Jesuits confronted with Martin Luther.

You can read their science-free responses and the attempts of those who seek to smoothe the waters by claiming there is a middle way in the Diabetes in Control article which you will find here:

The fact is, there is no middle way. The low glycemic/high carbohydrate diet is very slightly better than a high glycemic/high carbohydrate diet, but it still produces blood sugars high enough to promote complications.

To avoid complications you need to get normal blood sugars, not slightly better diabetic blood sugars. To do that, you need to cut out a lot of carbs. Twenty percent works for many. I still need to use a bit of meal time insulin with a carb intake that high, but with insulin it works for me. Without fast acting meal time insulin, I need to drop to around 15% to get decent control.

The reason to highlight this presentation, though, is that for the very first time, a researcher has had the nerve to point to the fact that the ADA's promotion of the high carbohydrate diet is a political decision, not one based on science.

This, in the world of science, is a big deal. It isn't quite an accusation of corruption, but it is close.

In fact, I believe the American Diabetes Association is corrupt, and that its corruption is due to the fact that it is heavily funded by commercial interests who lose money when people with diabetes use an effective diet to control their blood sugar instead of drugs that cost almost $200 a month. Look at the cheap food conglomerates who sponsor the ADA and ask yourself how many of them sell high quality protein foods free of corn syrup, hydrogenated fats, and lots and lots of sugar and starch.

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I'm off now to see my endo for my semi-annual checkup. My A1c will probably be higher than I'd like, because I had the flu three weeks ago. It's always higher than I expect, and because I was feverish for a few days and had high blood sugars much of the week I expect it to be even higher this time. In fact, save for when I was sick, I have kept my blood sugar under very good control throughout the last six months and even managed to knock off a few pounds, too.

Back later. . . .

My A1c turned out to be 5.8% which considering that I was seeing a bunch of 180s after meals the week after I had flu and the test was a week after that was extremely good news. Outside of the flu I thought I had been doing well. I'm also down 10 lbs since April, which is what I thought too. Partly that is due to going back on metformin, partly to getting food poisoning last summer which kept me from eating food for a week, and partly from the flu. I'll take it.

My blood pressure had shot up again--it's been fluctuating wildly of late since I got sick and can be anywhere from from 90/60 to 160/113 with no obvious explanation for why. It was fine yesterday--I measure at home--but it was awful at the office and on my home machine too. Back onto the Diovan!

I've been supplementing with 2000 IU of Vitamin D all year and she tested my Vitamin D level. It was 51, which is okay but I'm going to add another 1000 IU to the daily intake since it could be better. Finally all the kidney tests, microalbumin, creatinine etc. were completely normal.

The doc suggested that it would have been a good idea not to take the metformin while feverish with flu, given that during fever we produce higher levels of lactic acid and tend to get dehydrated. That's a bit of info to stash away for future use. I have been very exhausted since getting over this flu and she suggested going off the metformin for a week to see if that helped.

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comments:

Your report on your recent check-up reminded me about something I've wondered about for a while. You've mentioned going on and off metformin a number of times over the years. I don't have any personal experience with metformin (yet) because I am still able to use diet for BG control, but all your good information on the meds is good to, as you say, stash away.

Does going on and off metformin (or any med) create any problems? Is it necessary to taper off off the metformin or can it be stopped and started abruptly without issue?

Metformin can be started or stopped at will, however it takes about 2 weeks for it to completely stop having an effect on blood sugar.

The endo has several times suggested I stop and restart metformin for various reasons.

There is no rebound when you stop--you should end up with the same sugars you had before you started it. There's no risk of anything bad happening either.

It is supposed to be most effective if you are insulin resistant, or if your liver is dumping a lot of glucose inappropriately (due to insulin resistance).

So since I'm not IR, metformin does nothing significant to my blood sugar but it has a major impact on my ability to lose (or gain) weight. I think this is because it affects triglyceride formation at the liver which is necessary for storing fat, but I can't document that.

My A1c a year ago when I hadn't been taking metformin for almost a year was the same 5.8% as now. But the 10 lbs I've lost in 6 months was a pleasant change from the slow but steady gain I was seeing without it.

I've really been enjoying your blog, Jenny. My Vitamin D was tragically low. the doc put me on 50,000 units of D to get it up. Since last April I've been off that and taking 2 g. of vitamin D/day. In August my level was 72. I also began walking outside at lunch for anywhere from 15-25 minutes for sun exposure. Now that we have less sun I added a gram of vitamin D, but will continue to walk as conditions allow. My experience with metformin (I was on it for many years) was that it had no effect on my weight, but did help with glucose levels. After I began eating very low carb, it ceased to make a difference as my glucose levels dropped. Eventually it was ineffective and I no longer take it. I do think it is a great drug, though.

Hi Jenny,Thanks for more good info. You mention taking Diovan for blood pressure. Coincidently, my husband just asked his doctor about switching to this medication (from Lisinopril--we think his cough is a side effect). The doctor didn't comment on Diovan, but gave him a sample of Hyzaar (he will prescribe something different if we ask). I just looked it up and read that it may cause blood sugar to rise. Would love to know your thoughts on this.

The study hits the same mark I have when it come to carbs and blood sugar. I had seperated from my wife and was living alone a few months back. My weight was up to 251 lbs, blood pressure 150/90, a1c wasn't too bad at 6.2. After 3 month of a low carb, higher protein diet, along with intense cycling program, my weight was down to 228, a1c was at 5.3, and blood pressure was 116/70. A couple of months later, my weight is back up to 240, a1c is 6.3, blood pressure back to 150/85. The reason? A new woman in my life. Dates, cooking at home with not the attention to carbs, less time to ride, cocktals and popcorn, you get the picture. And it's not good. We have agreed to get back on the horse and resume a healthy life style. The carrot? I won't marry her until another 40 lbs are off my numbers are acceptable again. I'm lucky she gets the picture since her daughter is type 1 and almost lost her unborn child due to complications from uncontrolled blood sugar, even though she has a pump. These are 2 hard lessons to be learned, but both can be controlled through hard work and diligence.Thanks for the great and informative blog for all of us out here fighting the good fight!

Long term adherence to the low carb diet is not easy. That is one reason I suggest people get the carbs as low as they can manage but not fear adding metformin or insulin to their regimens. If a person can maintain at 100 g a day with the drugs, but can't get down to, say, 45, they will do better long term at the slightly higher level that they can STICK to.

That's why the low carb diet for control is so very different from the weight loss diet. Because it has to be something you can stick to.

Jenny is correct about sustainability. I've lived with type 1 diabetes for over 30 years and it is imperative that you find an eating plan that is satisfying for you. Controlling your blood sugar and you weight are two different matters. Long term BG control requires years and years of consistency. None of this on again off again stuff. You have to find a happy spot even if it means using insulin, which is not the end of the world.

And Boz, you can't make other people responsible for your adherence to your eating plan. You have to learn to live in a world of popcorn eaters and still eat to your plan. You can't expect others to adopt your eating plan. You are responsible for your blood sugar and what goes in your mouth.

Low carbing as a type 1 presents very different challenges such as dealing with gluconeogenesis and the possibility of dangerously low blood sugars as well as too much weight loss. Most of us are not insulin resistant and have a higher threshold of carb tolerance as far as weight loss. I will lose at anything under 80 carbs per day. I also develop hypoglycemia unawareness when my glycogen stores are not intact so, like Jenny, I'm a 100 carb a day girl with A1Cs in the low 5s.

All type 1 pregnancies are very high risk because of the hormonal fluctuation and their action on blood sugar. Luckily I was one of the few who had better BGs while pregnant than non-pregnant. I wish to God I had had a pump as they are amazing in providing a steady, readily-absorbed basal insulin. You don't walk in our shoes and don't have our issues. Don't be so judgmental of your girlfriend's daughter.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.